Wednesday, July 23, 2008

Talk about conflicts of interest

Mention conflicts of interest and the pharmaceutical industry immediately comes to mind. But there are many other conflicts in day to day practice of medicine which are ignored in public debate. Here are a few that were uncovered in a recent Reader’s Digest interview of two dozen doctors:

Hospitals want physicians to send patients home faster, so some doctors are given bonuses for getting their patients out of the hospital quickly.

Doctors respond to market forces. If the reimbursement system is fee-for-service, that results in more services. If you build a new CT scan, someone will use it, even though having a procedure you don't need is never a good thing.

Doctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten.

Not a day goes by when I don't think about the potential for being sued. It makes me give patients a lot of unnecessary tests that are potentially harmful, just so I don't miss an injury or problem that comes back to haunt me in the form of a lawsuit.

In most branches of medicine, we deal more commonly with old people. So we become much more enthusiastic when a young person comes along. We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time.